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Diabetic Nephropathy (Kidney Disease)

What is diabetic kidney disease?

Diabetic kidney disease (DKD) is kidney disease that is due to diabetes. It is also called diabetic nephropathy. Nephropathy means your kidneys are not working well.

Both type 1 and type 2 diabetes are the most common cause of kidney disease.

There are 5 stages of DKD. The final stage is kidney failure (end-stage renal disease or ESRD). Going from one stage to the next can take many years.

What causes diabetic kidney disease?

Both high blood pressure and high blood sugar damage the kidneys.

As kidney disease gets worse, physical changes in the kidneys often lead to higher blood pressure.

Uncontrolled high blood pressure can speed the progress toward ESRD.

High blood sugar linked to diabetes damages the kidney in several different ways. Mainly, it damages the blood vessels that filter the blood to make urine.

What are the symptoms of diabetic kidney disease?

At first, most people with DKD don't have symptoms. Having your kidney function checked is the only way to know if there are problems. Over the years, as kidney disease develops, small amounts of the blood protein albumin begin to show in your urine. This first stage of chronic kidney disease is called moderately increased albuminuria (microalbuminuria). The kidneys can still filter waste during this stage.

As the disease worsens, more albumin leaks into the urine. This stage may be called severely increased albuminuria (macroalbuminuria). As the albumin increases, the kidneys can’t cleanse the blood as well. Wastes are left in the blood. Blood pressure often rises as well.

It is rare for kidney damage to happen in the first 10 years of diabetes. Kidney failure often happens 15 to 25 years after the first symptoms of diabetes. If you have had diabetes for more than 25 years without any signs of kidney failure, your risk of having it decreases.

How is diabetic kidney disease diagnosed?

If you have diabetes, it’s important to be checked regularly for kidney disease. To do this, your healthcare provider will monitor the waste products in your blood and urine. Your provider will test your urine to check for a protein called albumin. Normally, urine should not have any albumin. Even a small amount of albumin in your urine is a sign of early kidney damage. The main waste product checked for in the blood is known as creatinine.

If kidney disease is found, your healthcare provider will address it as part of your diabetes treatment plan.

What is the treatment for diabetic kidney disease?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Not taking other medicines that harm the kidneys. These include some pain medicines (NSAIDS) as well as even some commonly used diabetes medicines that are not safe to use in people with advanced kidney disease (or which may need to be used in smaller doses.) If your DKD becomes more severe, you will need a referral to a kidney specialist (nephrologist).

For kidney failure, you will need dialysis to cleanse the blood. Dialysis is a process to filter the toxins out of the blood.

Over time, kidney transplant may also be a consideration.

Can diabetic kidney disease be prevented?

The progression of DKD can be slowed by closely managing diabetes. This includes:

Watching your A1C level

eating a healthy diet

Exercising

Not smoking

Staying at a healthy weight

Getting enough sleep

Limiting alcohol

Taking medicines to lower blood pressure

Taking a statin medicine to improve lipid control

Key points about diabetic kidney disease

Diabetic kidney disease is kidney disease that is due to diabetes.

Both type 1 and type 2 diabetes are the most common cause of kidney disease.

There are 5 stages of the disease. The final stage is kidney failure. Going from one stage to the next can take many years.

Most people don't have symptoms. Having your kidney function checked is the only way to know if there are problems.

Have your urine tested regularly to check for a protein called albumin. Even a small amount of albumin in your urine is a sign of early kidney damage.